Healthcare Provider Details

I. General information

NPI: 1497346571
Provider Name (Legal Business Name): AUSTIN THOMAS FIDLER HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 N EVERBROOK LN
MUNCIE IN
47304
US

IV. Provider business mailing address

11367 EAST 900 SOUTH-27
HARTFORD CITY IN
47348
US

V. Phone/Fax

Practice location:
  • Phone: 765-587-3630
  • Fax:
Mailing address:
  • Phone: 765-251-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberIL.03424
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001530A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: